Appearance-based nail stress, self-esteem, and health-related quality of life: a cross-sectional study in Korean adults

Appearance-related stress arising from visible nail discoloration and deformation has received increasing attention as a potential psychosocial concern with implications for psychological functioning and HRQoL. Although nails are publicly exposed and play a central role in social communication and hygiene perception, limited research has examined their psychosocial impact within a behavioral medicine framework. This study examined associations among nail-related appearance stress, self-esteem, and HRQoL among adults in South Korea. A cross-sectional online survey was administered to 510 adults aged 19–69 who reported at least one nail abnormality. Measures included physical stress, emotional stress, self-esteem, and five HRQoL domains: symptoms, function, emotion, psychological recovery, and life satisfaction. Structural equation modeling (SEM) using SPSS 26.0 and AMOS 25.0 tested the proposed mediation model. Appearance-related nail stress was significantly associated with lower self-esteem (β = –0.42, p < .001) and lower HRQoL (β = –0.38, p < .001). Self-esteem partially mediated the associations between physical stress and HRQoL (indirect effect = 0.21; 95% CI [0.12–0.32]; Z = 4.56; p < .001) and between emotional stress and HRQoL (indirect effect = 0.18; 95% CI [0.09–0.28]; Z = 4.23; p < .001). These mediation pathways accounted for a meaningful proportion of variance across HRQoL domains, indicating that psychological interpretations of nail abnormalities may be more strongly associated with perceived wellbeing than physical symptoms alone. The findings suggest that nail-related appearance stress may have relevance within psychosocial and behavioral health research, particularly in relation to emotional well-being, social participation, and stigma-related experiences. The findings highlight the importance of appearance-sensitive communication and psychosocial support for individuals experiencing nail-related appearance concerns. These findings suggest that perceived nail-related stress may be associated with psychological functioning and quality of life. However, causal interpretations are limited by the cross-sectional design, and further research is needed to clarify these relationships.